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1.
J Cardiol ; 2024 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-38906415

RESUMEN

BACKGROUND: Patients with intermediate-risk pulmonary embolism (PE) and normotensive shock may have worse outcomes. However, diagnosis of normotensive shock requires invasive hemodynamics. Our objective was to assess the predictive value of McConnell's sign in identifying normotensive shock in patients with intermediate-risk PE. METHODS: Patients with intermediate-risk PE who underwent percutaneous mechanical thrombectomy between August 2020 and April 2023 at a large academic public hospital were included in the study. Normotensive shock was defined as systolic blood pressure ≥ 90 mmHg without vasopressor support with pre-procedural invasive measures of cardiac index ≤2.2 L/min/m2 and clinical evidence of hypoperfusion (i.e. elevated lactate, oliguria). The primary outcome was the association between McConnell's sign and normotensive shock. RESULTS: Those with McConnell's sign (29/40, 72.5 %) had higher heart rate (114 vs 99 beats/min, p = 0.008), higher rates of elevated lactate (86 % vs 55 %, p = 0.038), lower cardiac index (1.9 vs 3.1 L/min/m2, p = 0.003), and higher rates of normotensive shock (76 % vs 27 %, p = 0.005). McConnell's sign had a sensitivity of 88 % and specificity of 53 % for identifying intermediate-risk PE patients with normotensive shock. Patients with McConnell's sign had an increased odds (odds ratio 8.38, confidence interval: 1.73-40.53, p = 0.008; area under the curve 0.70, 95 % confidence interval: 0.56-0.85) of normotensive shock. CONCLUSION: This is the first study to suggest that McConnell's sign may identify those in the intermediate-risk group who are at risk for normotensive shock. Larger cohorts are needed to validate our findings.

3.
Curr Cardiol Rep ; 26(5): 393-404, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38526749

RESUMEN

PURPOSE OF REVIEW: Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. RECENT FINDINGS: The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.


Asunto(s)
Infarto del Miocardio , Humanos , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/complicaciones , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea , Corazón Auxiliar/efectos adversos , Ecocardiografía/métodos , Ecocardiografía Doppler en Color
5.
J Glob Antimicrob Resist ; 33: 368-375, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-37019210

RESUMEN

OBJECTIVES: Systemic strategies for combating antimicrobial resistance (AMR) currently focus on limiting antibiotic use and have been generally insufficient in preventing the rise of AMR. Additionally, they often generate other adverse incentives, such as discouraging pharmaceutical companies from investing in research and development of new antibiotics, further exacerbating the problem. This paper proposes a novel systemic strategy for tackling AMR, which we term 'antiresistics': any intervention (whether a small molecule, genetic element, phage, or whole organism) that reduces resistance rates in pathogen populations. A prime example of an antiresistic would be a small molecule that specifically disrupts the maintenance of antibiotic resistance plasmids. Of note, an antiresistic would be expected to have a population-level effect and not necessarily be useful on a time scale relevant to individual patients. METHODS: We developed a mathematical model to assess the effect of antiresistics on population resistance levels and calibrated it to longitudinal data available at the country level. We also estimated potential effects on idealised rates for the introduction of new antibiotics. RESULTS: The model shows that greater use of antiresistics allows for greater usage of existing antibiotics. This leads to an ability to maintain a constant overall rate of antibiotic efficacy with a slower rate of developing new antibiotics; subsequently, antiresistics have a positive benefit on the effective lifetime and thus profitability of antibiotics. CONCLUSIONS: By directly reducing resistance rates, antiresistics can provide clear qualitative benefits (which may be quantitatively large) in terms of existing antibiotic efficacy, longevity, and alignment of incentives.


Asunto(s)
Antibacterianos , Humanos , Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana
6.
Nanomaterials (Basel) ; 12(21)2022 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-36364659

RESUMEN

Green and renewable energy is the key to overcoming energy-related challenges such as fossil-fuel depletion and the worsening of environmental habituation. Among the different clean energy sources, hydrogen is considered the most impactful energy carrier and is touted as an alternate fuel for clean energy needs. Even though noble metal catalysts such as Pt, Pd, and Au exhibit excellent hydrogen evolution reaction (HER) activity in acid media, their earth abundance and capital costs are highly debatable. Hence, developing cost-effective, earth-abundant, and conductive electrocatalysts is crucial. In particular, various two-dimensional (2D) transition metal carbides and their compounds are gradually emerging as potential alternatives to noble metal-based catalysts. Owing to their improved hydrophilicity, good conductivity, and large surface areas, these 2D materials show superior stability and excellent catalytic performances during the HER process. This review article is a compilation of the different synthetic protocols, their impact, effects of doping on molybdenum and tungsten carbides and their derivatives, and their application in the HER process. The paper is more focused on the detailed strategies for improving the HER activity, highlights the limits of molybdenum and tungsten carbide-based electrocatalysts in electro-catalytic process, and elaborates on the future advancements expected in this field.

7.
Echocardiography ; 38(11): 1970-1972, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34713478

RESUMEN

Rhythm control strategies in patients with esophageal varices and atrial arrhythmias pose a unique challenge. The left atrium should be imaged for a thrombus prior to attempting cardioversion or ablation, but the presence of varices is a relative contraindication for transesophageal echocardiography. We present a safe, novel technique of evaluating for left atrial thrombus with simultaneous transesophageal echocardiography and esophagogastroduodenoscopy using slim probes in a patient with large, high-risk esophageal varices, and symptomatic atrial flutter with rapid ventricular rates despite medical therapy.


Asunto(s)
Fibrilación Atrial , Aleteo Atrial , Várices Esofágicas y Gástricas , Anticoagulantes , Ecocardiografía Transesofágica , Cardioversión Eléctrica , Endoscopía , Várices Esofágicas y Gástricas/complicaciones , Várices Esofágicas y Gástricas/diagnóstico por imagen , Humanos
8.
J Cardiovasc Comput Tomogr ; 8(1): 85-7, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24582048

RESUMEN

Aneurysms of the branches of the coronary arteries are rare. We report a case of a right coronary artery aneurysm with aneurysmal dilation and thrombosis of the sinoatrial nodal branch presenting as a right atrial mass. The patient underwent multiple imaging evaluations before coronary CT angiography diagnosed aneurysm and thrombosis of the sinoatrial nodal branch.


Asunto(s)
Aneurisma Coronario/complicaciones , Aneurisma Coronario/diagnóstico por imagen , Trombosis Coronaria/complicaciones , Trombosis Coronaria/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Nodo Sinoatrial/diagnóstico por imagen , Anciano , Angiografía Coronaria/métodos , Diagnóstico Diferencial , Dilatación Patológica , Femenino , Atrios Cardíacos/anomalías , Humanos , Tomografía Computarizada por Rayos X/métodos
10.
J Am Soc Echocardiogr ; 16(11): 1204-10, 2003 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-14608297

RESUMEN

BACKGROUND: Patients after cardiac operation pose a challenge to the treating physician-these patients may become critically ill and are among the most difficult to image using transthoracic echocardiography. Several factors contribute to this, including difficulties in positioning the patient, inability of the patient to cooperate with instructions, surgical dressings, and hyperinflated lungs. Transesophageal echocardiography may be performed when transthoracic echocardiography is not diagnostic; however, transesophageal echocardiography is semi-invasive and does not lend itself to prolonged or repeated monitoring. METHODS: Recently, a new approach to echocardiography for use in the patient after operation has been introduced with the modification of the standard mediastinal drainage tube to allow for substernal epicardial echocardiography (SEE). The SEE tube has 2 lumens. The first allows for routine mediastinal drainage and the second has a blind end that permits the insertion of a standard transesophageal echocardiographic probe for high-resolution imaging as often as is desired over the period during which the mediastinal tube is in place. CONCLUSION: This article reviews the technique of SEE including a description of the method of performance of SEE (with representative images), a review of the published literature on this new modality, examples of clinical use, and a discussion of the advantages, indications, and limitations of SEE with an eye toward future directions for research.


Asunto(s)
Ecocardiografía Transesofágica/métodos , Ecocardiografía/métodos , Pericardio/diagnóstico por imagen , Esternón/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Ecocardiografía/instrumentación , Ecocardiografía Transesofágica/instrumentación , Diseño de Equipo/instrumentación , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Cuidados Intraoperatorios/instrumentación , Cuidados Intraoperatorios/métodos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Cuidados Posoperatorios/instrumentación , Cuidados Posoperatorios/métodos
12.
Am J Cardiol ; 90(12): 1320-5, 2002 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-12480041

RESUMEN

Severe aortic plaques seen on transesophageal echocardiography (TEE) are a high-risk cause of stroke and peripheral embolization. Evidence to guide therapy is lacking. Retrospective information was obtained regarding the occurrence of embolic events (stroke, transient ischemic attacks, or peripheral emboli) in 519 patients with severe thoracic aortic plaque seen on TEE since 1988. Treatment with statins, warfarin, or antiplatelet medications was noted. Treatment was not randomized. In a matched-paired analysis, each patient taking each class of therapy was matched for age, gender, previous embolic event, hypertension, diabetes, congestive failure, and atrial fibrillation to someone not taking that medication. Multivariate analysis was also performed. An embolic event occurred in 111 patients (21%). Multivariate analysis showed that statin use was independently protective against recurrent events (p = 0.0001). Matched analysis also showed a protective effect of statins (p = 0.0004; absolute risk reduction 17%, relative risk reduction 59%, number needed to treat [n = 6]). No protective effect was found for warfarin or antiplatelet drugs. The odds ratio for embolic events was 0.3 (95% confidence interval [CI] 0.2 to 0.6) for statin therapy, 0.7 (95% CI 0.4 to 1.2) for warfarin, and 1.4 (95% CI 0.8 to 2.4) for antiplatelet agents. Thus, there is a protective effect of statin therapy, and no significant benefit of warfarin or antiplatelet drugs on the incidence of stroke and other embolic events in patients with severe thoracic aortic plaque on TEE.


Asunto(s)
Anticoagulantes/uso terapéutico , Enfermedades de la Aorta/tratamiento farmacológico , Arteriosclerosis/tratamiento farmacológico , Embolia/epidemiología , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular/epidemiología , Anciano , Aorta Torácica/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico por imagen , Arteriosclerosis/diagnóstico por imagen , Ecocardiografía Transesofágica , Embolia/prevención & control , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Análisis Multivariante , Oportunidad Relativa , Estudios Retrospectivos , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento , Warfarina/uso terapéutico
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